Impact of Diabetes Mellitus on the Clinical Management of Global Cardiovascular Risk: Analysis of the Results of the Evaluation of Final Feasible Effect of Control Training and Ultra Sensitization (EFFECTUS) Educational Program

Abstract

Background: The Evaluation of Final Feasible Effect of Ultra Control Training and Sensitization (EFFECTUS) study is aimed at implementing global cardiovascular (CV) risk management in Italy. Hypothesis: To evaluate the impact of diabetes mellitus (DM) on attitudes and preferences for clinical management of global CV risk among physicians treating diabetic or nondiabetic patients. Methods: Involved physicians were asked to submit data into a study-designed case-report form, covering the first 10 adult outpatients consecutively seen in May 2006. All available clinical data were centrally analyzed for global CV risk assessment and CV risk profile characterization. Patients were stratified according to the presence or absence of DM. Results: Overall, 1078 physicians (27% female, ages 50 ± 7 y) collected data of 9904 outpatients (46.5% female, ages 67 ± 9 y), among whom 3681 (37%) had a diagnosis of DM at baseline. Diabetic patients were older and had higher prevalence of obesity, hypertension, dyslipidemia, and associated CV diseases than nondiabetic individuals (P < 0.001). They had higher systolic blood pressure, total cholesterol, triglycerides, and creatinine levels, but lower high-density lipoprotein cholesterol levels than nondiabetic patients (P < 0.001). Higher numbers of blood pressure and lipid-lowering drugs and antiplatelet agents were used in diabetic than in nondiabetic patients (P < 0.001). Conclusions: The EFFECTUS study confirmed higher CV risk and more CV drug prescriptions in diabetic than in nondiabetic patients. Presence of DM at baseline significantly improved clinical data collection. Such an approach, however, was not paralleled by a better control of global CV risk profile, which was significantly worse in the former than in the latter group. Introduction Diabetes mellitus (DM) affects approximately 100 million persons worldwide. In view of the increasing prevalence of unfavorable lifestyle habits (eg, smoking, physical inactivity, and high-caloric diet) and associated clinical conditions (obesity, atherogenic dyslipidemia, and hypertension), it is likely that its incidence will further and dramatically rise in both Western and developing countries in the next decades.Nowadays, both general practitioners and specialized physicians are encountering many of these patients in their routine clinical practice, thus having the opportunity to substantially reduce the global burden of disease related to DM and glucose abnormalities. 1,2 Diabetic patients have, in fact, higher susceptibility than nondiabetic individuals to develop major cardiovascular (CV) events, such as myocardial infarction, stroke, and CV death, and non-CV mortality. 3,4 Because CV diseases represent the main causes of death and disability in people with DM, physicians must recognize the key role of this clinical condition to promptly stratify and timely treat these patients. Evidence has, in fact, demonstrated that a therapeutic approach based on global CV risk management may effectively reduce the burden of CV disease in diabet...

Achievement of multiple therapeutic targets for cardiovascular disease prevention: Retrospective analysis of real practice in Italy

“…The present study has some potential limitations that should be acknowledged . First of all, it is based on a large, cross‐sectional, descriptive survey.…”

“…The Evaluation of Final Feasible Effect of Control Training and Ultra‐sensitisation (EFFECTUS) survey showed a very high prevalence of CV risk factors among adult outpatients followed by different groups of Italian physicians, mostly general practitioners (GPs) . Further analyses from the same database were performed to detect potentially different approaches according to local disparities, availability of electronic support, and predefined subsets of outpatients, such as those with DM or HTN . However, specific analysis testing the achievement of different multiple therapeutic targets according to risk score estimation was not available.…”

Impact of Hypertension on Global Cardiovascular Risk Stratification: Analysis of a Large Cohort of Outpatient Population in Italy

“…The main findings from these analyses provided useful information on how adult outpatients having multiple concomitant CV risk factors and comorbidities were followed in our country . In all these analyses, hypertension represented by far the most frequent concomitant CV risk factor, compared with any other risk factor or clinical condition …”

“…In the past, we had the opportunity to analyze clinical characteristics and the global CV‐risk profile of adult outpatients included in a large, multicenter, observational study performed in Italy . The main findings from these analyses provided useful information on how adult outpatients having multiple concomitant CV risk factors and comorbidities were followed in our country . In all these analyses, hypertension represented by far the most frequent concomitant CV risk factor, compared with any other risk factor or clinical condition …”

Exacerbation of Glycoprotein VI-Dependent Platelet Responses in a Rhesus Monkey Model of Type 1 Diabetes

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